Objective ·To construct a framework nucleic acid-based linear amplification platform for the sensitive and quantitative detection of bladder cancer-related microRNAs (miRNAs), facilitating early screening and accurate diagnosis of bladder cancer. Methods ·This study combined a plasma fluorescence-enhanced chip with high-performance tetrahedral framework nucleic acid (tFNA) probes, targeting miRNAs as biomarkers, to construct a framework nucleic acid-based linear signal amplification platform for precise and high-throughput quantitative analysis of multiple targets. First, atomic force microscope (AFM) was used to verify the efficient synthesis of tFNA. The signal linear amplification capability of the reporter unit was verified by polyacrylamide gel electrophoresis (PAGE) and total internal reflection fluorescent microscope (TIRFM). The performance of the sensing interface substrates was compared, and the golden island chip with signal amplification was selected. The specificity of the detection system was verified by an interface specificity experiment. Five bladder cancer-related miRNAs were selected to construct standard curves for quantitative detection. Results ·The efficient synthesis of tetrahedral monomer and dimer structures was verified by AFM. PAGE and TIRFM characterization verified the linear amplification of fluorescence signals from 1 to 6 valence fluorescence reporter units. In order to achieve further signal amplification, the plasma island chip and the traditional glass chip were compared. The results showed that the gold island chip exhibited a plasmonic effect, which significantly enhanced the near-infrared (NIR) fluorescence, with a signal amplification of up to 13.6 times compared to the glass chip. The specificity verification experiment showed that the signal-to-noise ratio of the system ranged from 7 to 10, demonstrating high specificity. Based on the high specificity of the system, along with the good interface regulation ability and linear amplification of the framework nucleic acid-based interface, dual-color parallel detection of the targets was finally realized. The working range was 100 fmol/L‒10 nmol/L (R²≥0.991), and the detection limit was as low as 100 fmol/L. Conclusion ·The establishment of this platform opens new avenues for highly sensitive quantitative analysis of biomarkers. Furthermore, the developed framework nucleic acid-based detection platform holds great potential for clinical diagnosis and prognosis of bladder cancer and other major diseases. Through early detection and precise subtype diagnosis, doctors can formulate more personalized treatment plans for patients, improving treatment efficacy and reducing unnecessary treatment plans and associated side effects. Therefore, this liquid biopsy technology not only provides new possibilities for early screening of bladder cancer but also serves as reference for research and clinical applications in other types of cancer.

Objective ·To investigate the therapeutic effects of neferine (Nef) on intervertebral disc degeneration (IDD) and the underlying regulatory pathways. Methods ·The effects of Nef on the viability and proliferation of nucleus pulposus cells were assessed using the cell counting kit-8 (CCK-8) assay. Molecular docking software was employed to analyze the potential binding sites of Nef within the Kelch domain of kelch-like ECH-associated protein 1 (KEAP1). Tumor necrosis factor-α (TNF-α) was used to induce ferroptosis and inflammation in nucleus pulposus cells. Western blotting was performed to detect the expression levels of nuclear factor erythroid 2-related factor 2/glutathione peroxidase 4 (NRF2/GPX4) pathway- and nuclear factor-κB (NF-κB) pathway-related proteins under TNF-α stimulation with or without Nef. The effect of Nef on the metabolism of extracellular matrix in nucleus pulposus cells was evaluated using high-density cell culture. A needle puncture-induced IDD rat model was established, and 5 µL of 1.5 μmol/L Nef was injected twice into the intervertebral disc at the Co3/4 level (IDD+Nef group), while an equivalent volume of PBS was injected into the Co2/3 disc (IDD group). After 4 weeks, the intervertebral space height was detected by X-ray, disc degeneration was detected by magnetic resonance imaging, and disc structure was evaluated by histological staining. Results ·The CCK-8 assay revealed that Nef at concentrations of 1.5 μmol/L and below did not inhibit the viability and proliferation of nucleus pulposus cells. Molecular docking results suggested that Nef might activate NRF2 by directly binding to the KEAP1 Kelch domain, thereby reducing the interaction between KEAP1 and NRF2. Western blotting indicated that Nef significantly increased the expression of the key ferroptosis-inhibiting proteins NRF2 and GPX4, while decreasing the expression of the phospho-P65 protein in the NF-κB pathway (all P<0.05). The high-density culture of nucleus pulposus cells demonstrated that Nef mitigated the TNF-α- induced degradation of the extracellular matrix (P<0.05). Animal study results showed that compared to the IDD group, the IDD+Nef group exhibited a greater intervertebral disc space height, a lower Pfirrmann grade (both P<0.05), and a reduced degree of histological degeneration. Conclusion ·Nef may inhibit TNF-α-induced ferroptosis in nucleus pulposus cells by activating the KEAP1/NRF2/GPX4 pathway and reduce TNF-α-induced inflammation and extracellular matrix degradation by suppressing the NF-κB pathway, thereby alleviating IDD in rats.

Objective ·To prepare self-assembled drug-loaded nanoprobes with activatable chemical exchange saturation transfer (CEST) imaging capability, and evaluate their imaging performance and therapeutic potential for photodynamic-sensitized pyroptosis in breast cancer in vivo and in vitro. Methods ·GC nanoprobes co-loaded with gemcitabine (Gem) and chlorin e6 (Ce6) were constructed by using a self-assembly strategy. The physicochemical properties of the GC nanoprobes were characterized by scanning electron microscopy (SEM) and dynamic light scattering (DLS). The pH-/time-dependent CEST activation and drug release profiles were investigated. The 2 ',7 '-dichlorodihydrofluorescein diacetate (DCFH-DA) probe was used to detect the generation of reactive oxygen species (ROS), and enzyme-linked immunosorbent assay (ELISA) was used to detect the release of inflammatory factors such as interleukin-1β (IL-1β) and IL-18 in mouse breast cancer 4T1 cells after treatment with GC nanoprobes with synergistic laser irradiation. Immunofluorescence was performed to detect immunogenic cell death (ICD) markers, including calreticulin (CRT) and high mobility group box 1 protein (HMGB1). The 4T1 breast cancer mouse models were established to validate tumor-specific CEST activation and evaluate anti-tumor efficacy by measuring tumor volume and detecting inflammatory factors and ICD markers. Results ·SEM and DLS confirmed the uniform spherical morphology of the GC nanoprobes. The CEST imaging results showed that the nanoprobes had excellent pH-concentration and time-dependent activation imaging effects both in the simulated acidic microenvironment and at the cellular level in vitro. The drug release from this drug-loaded nanoprobe was 80% at pH 5.0, which was significantly higher than at pH 7.4 ( P=0.003). DCFH-DA fluorescence staining demonstrated that GC-mediated photodynamic therapy induced a significant generation of ROS. Analysis of pyroptosis-related factors revealed a marked increase in the release levels of IL-1β and IL-18 (both P<0.05), along with elevated fluorescence expression of CRT and HMGB1. The in vivo CEST imaging results showed that the CEST signal at the tumor site was significantly enhanced, peaking at 4 h with tail vein injection of GC. The GC nanoprobes with synergistic laser irradiation group showed markedly elevated inflammatory factors (IL-1β, IL-18), changed ICD biomarkers (HMGB1 and CRT), and significant tumor suppression, compared to the PBS control group (all P<0.05) . Conclusion ·The GC nanoprobes enables specific CEST imaging-guided photodynamic therapy, effectively inducing pyroptosis and precise ablation of breast cancer.

Objective ·To screen a long non-coding RNA (lncRNA) signature and construct a competing endogenous RNA (ceRNA) network associated with the prognosis of pediatric sepsis based on the Gene Expression Omnibus (GEO) database, and explore their potential application value in the prognosis assessment of children with sepsis. Methods ·Microarray data in GSE4607, GSE26440, GSE26378, and GSE9692 in the GEO database were used to compare the differences in lncRNA profiles between the survival and non-survival groups of children with septic shock. Then, multivariate linear regression, LASSO analysis, and receiver operating characteristic (ROC) curves were used to evaluate the capacity of the lncRNA signature for predicting the outcome of pediatric sepsis. The potential targeted microRNAs (miRNAs) and their downstream mRNAs, targeted by the screened lncRNAs, were used to construct a protein-protein interaction (PPI) network and perform pathway enrichment analysis. Results ·Transcriptomic data from GSE4607, GSE26440, GSE26378 and GSE9692 revealed 55 differentially expressed lncRNAs associated with prognosis, and miR503 host gene (MIR503HG), TAPT1 antisense RNA 1 (TAPT1-AS1), apoptosis-associated transcript in bladder cancer (AATBC), SBF2 antisense RNA 1 (SBF2-AS1), MGC16275, and small nucleolar RNA host gene 15 (SNHG15) were identified as a 6-lncRNA signature (lncSig6) associated with the prognosis of pediatric septic shock by LASSO regression analysis. The area under the ROC curve (AUC) of lncSig6 was 0.859 (95% CI 0.722‒0.996) and 0.854 (95% CI 0.687‒1.000) in internal and external validation, respectively. As lncRNA act as miRNA sponge, a lncRNA-miRNA-mRNA network based on 3 lncRNAs (MIR503HG, SNHG15, and SBF2-AS1) was constructed and involved in the regulation of signaling pathways, including forkhead box O (FoxO) signaling pathway, phosphatidylinositol 3 kinase-protein kinase B (PI3K-AKT) signaling pathway, cell senescence, insulin signaling pathway, hypoxia-inducible protein-1 (HIF-1) signaling pathway and advanced glycation end products (AGEs) and receptor of AGEs (RAGE) signaling pathway. Conclusion ·The lncSig6 can be used as an evaluation method to predict the prognosis of septic shock in children, and the constructed ceRNA molecular networks can provide an experimental basis for the study of signaling pathways.

Objective ·To investigate the association of insulin resistance with left ventricular (LV) remodeling after ST-segment elevation myocardial infarction (STEMI) in patients without a history of diabetes mellitus. Methods ·This study consecutively enrolled STEMI patients without a history of diabetes mellitus who underwent percutaneous coronary intervention in the Department of Cardiology of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2014 to December 2022. The patients were followed up for 6 months. Age, gender, smoking status, blood pressure, body mass index, biochemical indexes (liver function, kidney function, lipid profiles, glycemic levels and peak troponin levels, etc.) and pharmacological treatment were recorded. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate insulin resistance and mean values of visit-to-visit HOMA-IR were calculated. Patients were divided into 4 groups (low-level group, low-to-medium-level group, medium-to-high-level group, and high-level group) according to the quartiles of mean HOMA-IR levels. Echocardiography was performed at baseline and during follow-up. Then the association between mean values of insulin resistance and post-infarction LV remodeling was analyzed. Results ·A total of 219 patients were finally included, with an average age of (62.7±11.9) years, and male patients accounted for 85.4% (187 cases). The average follow-up time was (6.4±1.8) months. During follow-up, the average number of HOMA-IR measurements was (4.32±2.18), and the mean value of visit-to-visit HOMA-IR was 2.41 (1.58, 3.98), which was higher than normal range. The results showed that post-infarction LV end-diastolic diameter (P=0.027) and LV end-diastolic volume index (P=0.013) generally showed a trend for dilation with increasing mean HOMA-IR levels. Pearson correlation analysis revealed the mean values of visit-to-visit HOMA-IR were positively correlated to changes in LV dimensions (Δ LV end-diastolic volume index: r=0.20, P=0.003; Δ LV end-diastolic diameter: r=0.21, P=0.002). Multivariate regression analysis demonstrated that higher HOMA-IR was independently associated with greater LV dilation after STEMI, even after adjusting for age, gender, traditional risk factors (history of hypertension, body mass index, smoking status, renal function and lipid profiles), pharmacological treatment, baseline LV ejection fraction and peak troponin levels. Compared with patients with the lowest quartile of HOMA-IR, those with the highest HOMA-IR quartile exhibited a 7.727 mL/m² increase in LV end-diastolic volume index (P<0.001). Conclusion ·This study reveals that insulin resistance is prevalent in STEMI patients without a history of diabetes mellitus. Insulin resistance is an independent predictor of adverse LV remodeling in this population.

Objective ·To evaluate the applicability of dual-unit cantilever restorations supported by a single narrow-diameter implant for consecutive missing teeth in the anterior mandibular region. Methods ·A simplified mandibular anterior jaw model and a dual-unit cantilever model supported by a single narrow-diameter implant were constructed. The dimensions of the mandibular anterior bone block were set to 20 mm (length), 5 mm (width), and 15 mm (height). The narrow-diameter implant used was the Axiom 2.8 two-stage implant, 2.8 mm×10 mm, paired with a 2.5 mm straight abutment. Based on calculations, the edentulous gap ranged from 5.8 mm to 11.6 mm, leading to the creation of seven crown models with mesiodistal widths of 5.8, 6.8, 7.8, 8.8, 9.8, 10.8, and 11.8 mm. The implant, crowns, and jaw model were assembled using Siemens Nx 12.0 software, and the data were imported into Ansys Workbench 18.0 for finite element analysis. A vertical load of 100 N and a 30° oblique load were applied to simulate occlusal forces. The Von-Mises stress on the implants, as well as the maximum compressive and tensile stresses in the cortical bone and the maximum tensile stress in the cancellous bone, was analyzed to investigate stress distribution under varying cantilever lengths. Results ·The implant neck region exhibited the highest stress concentration. As the cantilever length increased, the peak Von-Mises stress on the implants, the maximum tensile stress in the cortical and cancellous bones, and the maximum compressive stress in the cortical bones all increased progressively. However, all stress values remained within physiological limits. The peak Von-Mises stress ranged from 141.52 MPa to 707.17 MPa, below the implant′s ultimate tensile strength of 930 MPa. The maximum tensile stress in the cortical bones (with a peak of 60.82 MPa in the 11.8 mm group) was below the cortical bone′s tensile strength limit of 100‒130 MPa. The maximum compressive stress in the cortical bone (with an absolute maximum value of 129.39 MPa in the 11.8 mm group) was below the cortical bone′s compressive strength limit of 170 to 190 MPa (absolute values). The maximum tensile stress in the cancellous bone ranged from 0.84 MPa to 4.70 MPa, which was below or close to its ultimate tensile strength of 2‒5 MPa. Conclusion ·Dual-unit cantilever restorations supported by a single narrow-diameter implant may represent a viable treatment option for consecutive missing teeth in the anterior mandibular region.

Objective ·To evaluate the detection efficacy and clinical value of non-invasive prenatal testing (NIPT) for identifying copy number variations (CNVs) in the recurrent 17p12 region, including the peripheral myelin protein 22 (PMP22) gene. Methods ·Pregnant women who underwent NIPT in the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine between July 2020 and April 2024 were enrolled. Clinical data of individuals indicated as high-risk for microdeletions/duplications in the 17p12 region based on NIPT results were collected. Follow-up was conducted to assess the results of subsequent prenatal diagnosis and chromosomal microarray analysis (CMA) performed on peripheral blood from both the pregnant women and their husband. The positive predictive value (PPV) of NIPT for detecting microdeletions/duplications in the 17p12 region, as well as the underlying causes of false positives, was analyzed. Pregnancy outcomes and related clinical phenotypes of fetuses and pregnant women diagnosed with 17p12 CNVs were followed up. Results ·A total of 61 858 pregnant women underwent NIPT testing. NIPT identified 24 cases (0.04%) as high-risk for CNVs in the 17p12 region, including six cases of high-risk 17p12 microduplication and 18 cases of high-risk 17p12 microdeletion. All 24 pregnant women received genetic counseling, and 21 (87.50%) underwent invasive prenatal diagnosis. Invasive prenatal diagnostic confirmed four fetuses with 17p12 microduplications, nine fetuses with 17p12 microdeletions, and eight fetuses with no abnormalities, yielding a PPV of 61.90% (13/21). CMA analysis of maternal peripheral blood in the eight false-positive cases revealed that all mothers carried 17p12 CNVs. Further analysis of pregnant women with NIPT-indicated maternal CNVs revealed that all of them carried relevant CNVs. Among the 20 women with successful follow-up, the majority had normal deliveries, with only one case choosing to terminate the pregnancy due to a de-novo fetal 17p12 microduplication. Normally delivered fetuses (average age: 1.5 years) were followed up without reporting any significant abnormalities. Of the 16 pregnant women carrying 17p12 CNVs, only two exhibited clinical phenotypes associated with these CNVs, while the others remained asymptomatic. Conclusion ·NIPT demonstrates favorable detection efficacy for CNVs in the 17p12 region. Maternal CNVs are the primary cause of false-positive NIPT results for this region.

Objective ·To establish Downs cephalometric norms for the Han Chinese aged 18‒25 with harmonious faces, and to analyze gender and regional characteristics. Methods ·A stratified sampling approach was used to recruit participants from seven geographic regions across China. Over 30 000 volunteers were screened, and 883 participants with harmonious faces were ultimately included. Basic demographic data were collected, and lateral cephalometric radiographs were taken. Hard tissue measurements were performed with Downs analysis (using anatomical porion). The data were then statistically analyzed to compare gender and regional differences in dentofacial structures. Results ·The gender differences in the four hard tissue measurements, the angle of convexity, A-B plane angle, mandibular plane angle, and occlusal plane angle, were statistically significant (P<0.001). Females showed larger values for the angle of convexity, mandibular plane angle, and occlusal plane angle, but smaller values for the A-B plane angle, compared to males. The gender differences in the interincisal angle, L1 to occlusal plane, L1 to mandibular plane, and U1 to AP plane were not statistically significant. There were regional differences in all 10 measurements of Downs analysis, though some regions shared common features. Specifically, the northeastern, eastern, and southern coastal regions exhibited a smaller facial angle, and larger mandibular plane angle, angle of convexity, occlusal plane angle, and U1 to AP plane. It suggested that, compared to inland regions, individuals from coastal regions tended to have more retrusive chins, steeper mandibular planes, more prominent upper incisors, and more convex hard tissue profiles. Conclusion ·Gender differences exist in the dentofacial hard tissue structures of Han Chinese adults with harmonious faces, primarily in skeletal measurements. Each region has its unique dentofacial characteristics, along with some common features. These differences should be taken into account in clinical diagnosis and treatment for the development of personalized and precise therapeutic strategies.

Objective ·To explore the risk factors affecting progression-free survival (PFS) in colorectal cancer (CRC) patients and establish a corresponding prognostic prediction model. Methods ·A retrospective cohort study was used for analysis, including 533 patients with surgically resected and pathologically confirmed colorectal adenocarcinoma at Tongren Hospital, Shanghai Jiao Tong University School of Medicine, who were randomly divided into a training set (373 cases) and a validation set (160 cases) in a 7:3 ratio. The included clinical data were analyzed using univariate and multivariate Cox proportional hazards models to explore independent factors affecting postoperative PFS in patients with CRC and to establish a clinical prognostic prediction model based on these factors. The discrimination and calibration of the prediction model were evaluated by using concordance index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and survival curve. The independent effects of age, gender, and American Joint Committee on Cancer (AJCC) cancer stage on prognosis were assessed using multivariate Cox regression analysis. Results ·Multivariate Cox regression analysis revealed that age, smoking history, liver disease, carbohydrate antigen 724 (CA724), and AJCC stage were independent factors influencing PFS. In the training set, the C-index of the PFS model was 0.69, with AUCs of 0.744 and 0.713 at 3 and 5 years, respectively. In the validation set, the C-index of the PFS model was 0.64, with AUCs of 0.706 and 0.683 at 3 and 5 years, respectively. The calibration curves showed that the prediction of PFS for the training and validation sets were close to the standard curve. The survival curves suggested that the progression rate of patients in the low-risk group was significantly lower than that in the high-risk group. Stratified analysis revealed that among patients aged ≥65 years, age, liver disease, and AJCC clinical stage were independent factors affecting postoperative PFS. Among patients aged <65 years, smoking history, CA724, and AJCC clinical stage were independent factors affecting postoperative PFS. For male patients, age, smoking history, CA724, and AJCC clinical stage were independent factors affecting postoperative PFS, while for female patients, liver disease, CA724, and AJCC clinical staging were independent predictors of postoperative PFS. Among patients with AJCC stage Ⅰ‒Ⅱ, age and smoking history were independent factors affecting postoperative PFS, whereas in those with AJCC stage Ⅲ‒⁠Ⅳ, age, liver disease, and CA724 were independent factors affecting postoperative PFS. Conclusion ·The PFS prognostic model established in this study for CRC patients has good discriminative ability and provides clinicians with an effective risk assessment tool.

Methods ·A total of 247 patients with unmedicated OCD diagnosed in the Mental Health Center, Shanghai Jiao Tong University School of Medicine from 2014 to 2018 were included and divided into an OCD group ( n=202), and an OCD+OCPD group ( n=45), and 107 healthy controls were recruited as a comparison group. Yale-Brown Obsessive-Compulsion Scale (YBOCS), BIS/BAS Scale, Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) were used to assess psychopathological features. Gender differences among the three groups were analyzed using the χ² test. One-way analysis of variance (ANOVA) was used to compare differences in demographic characteristics, psychopathological features, and BIS/BAS scores, followed by the least significant difference (LSD) test for pairwise comparisons. Regression analysis was conducted to explore the relationships between psychopathological features and BIS/BAS scores. Results ·There were no significant differences in gender, age, and years of education among the three groups. The scores of YBOCS ( t=2.925, P=0.004), HAMD ( t=2.130, P=0.034) and HAMA ( t=2.568, P=0.011) in the OCD+OCPD group were significantly higher than those in the OCD group. There were statistically significant differences in BIS and BAS scores among the three groups (BIS: F=39.573, P<0.001; BAS: F=3.915, P=0.021). The results showed that for BIS, there were statistically significant differences in pairwise comparisons among the three groups (OCD+OCPD vs OCD: P=0.002; OCD+OCPD vs HC: P<0.001; OCD vs HC: P<0.001), and the scores were OCD+OCPD<OCD<HC from low to high. For BAS, the OCD group scored significantly higher than the OCD+OCPD and HC groups (OCD+OCPD vs OCD: P=0.018; OCD vs HC: P=0.043), but there was no significant difference between the OCD+OCPD and HC groups. Regression models of BIS and BAS were constructed for OCD patients with OCPD, and the results showed that the overall prediction effect of the model was significant for BIS total scores ( F=2.599, P=0.013). Only the severity of OCPD symptoms can significantly predict BIS scores ( t=-2.282, P=0.023). For BAS total scores, the overall prediction effect of the model was not significant ( F=1.438, P=0.191). Conclusion ·Comorbid OCPD may be an adverse factor for abnormal BIS and a protective factor for abnormal BAS in patients with OCD. Object ·To explore the effects of comorbid obsessive-compulsive personality disorder (OCPD) on the behavioral inhibition system (BIS)/behavioral activation system (BAS) in patients with obsessive-compulsive disorder (OCD).

Objective ·To detect the active brain regions in patients experiencing pain associated with temporomandibular disorder under anxiety emotion stimulation by using functional magnetic resonance imaging (fMRI). Methods ·A total of 30 temporomandibular disorder patients with spontaneous pain were included, who visited the Department of Stomatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, from November 2021 to September 2023. A task program consisting of negative and medium pictures chosen from the International Affective Picture System (IAPS) was used to stimulate anxiety in the volunteers during fMRI scanning. The activated brain regions were identified by processing the data with the general linear model using FSL 5.0.6 software. The pain levels and anxiety levels of the subjects before and after anxiety stimulation were recorded by using the Visual Analogue Scale (VAS) and State-Trait Anxiety Inventory (STAI). Paired t-tests were then conducted by using SPSS 20.0 software. Results ·After stimulation with negative pictures, the anxiety levels of the subjects with temporomandibular disorder significantly increased ( P<0.001), and the pain levels also worsened ( P<0.001). The degree of temporomandibular joint pain aggravated with the stimulation of negative emotional pictures and improved with the neutral pictures. The main brain regions activated during the task included amygdala, hippocampus, anterior cingulate gyrus, thalamus, occipital cortex, and insula. Among them, the occipital cortex, anterior cingulate gyrus, and amygdala were the main brain regions activated after removing neutral control stimulation. Conclusion ·The aggravation of anxiety can increase the temporomandibular joint pain level in patients with temporomandibular disorder. There is significant activation in the brain regions related to the hippocampus-centered hyperalgesia reaction and the thalamic-limbic system and the thalamic-limbic system, which are involved in pain and emotion regulation networks.

Objective ·To explore the effect of intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex (DLPFC) on reducing craving in alcohol-dependent patients during the withdrawal period, as well as its impact on patients' emotions and cognitive functions. Methods ·A total of 41 inpatients with alcohol dependence in the withdrawal period were recruited from the Addiction Department of Mental Health Center, Shanghai Jiao Tong University School of Medicine, and randomly assigned to the experimental group (20 patients) and the control group (21 patients). Both groups received routine inpatient treatment for alcohol-dependence. The experimental group received real iTBS stimulation targeting the left DLPFC on the basis of routine inpatient treatment, while the control group received sham stimulation with the same parameters. The intervention course lasted for 2 weeks, with a total of 10 sessions. The Visual Analogue Scale (VAS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to measure the craving, anxiety, and depression of the patients before and after the intervention. The behavioral tasks of the detection task (DET), identification task (IDN), two back task (TWOB), the Groton maze learning task (GML), and international shopping list task (ISL) in the CogState software package were used to assess the cognitive processing speed, attention/vigilance, working memory, spatial problem-solving/error monitoring ability, and verbal learning and memory of the patients before and after the intervention. Results ·Repeated measures ANOVA showed that the time effect [F=126.713, P<0.001, partial η² (η_p²)=0.765] and interaction effect (F=7.080, P=0.011, η_p²=0.154) of the VAS scores in the two groups of patients were statistically significant. The time effect (F=9.114, P=0.004, η_p²=0.189), group effect (F=5.557, P=0.024, η_p²=0.125), and interaction effect (F=4.977, P=0.032, η_p²=0.113) of the TWOB score were all statistically significant. Only the time effects of BDI (F=45.273, P<0.001, η_p²=0.578), BAI (F=31.432, P<0.001, η_p²=0.473), GML (F=8.993, P=0.005, η_p²=0.209), and ISL (F=26.657, P<0.001, η_p²=0.439) scores were statistically significant. There were no statistically significant effects of time, group, or interaction on the DET and IDN scores. Simple effect analysis showed that the VAS score of the real stimulation group was lower than that of the sham stimulation group after the intervention (F=8.805, P=0.005, η_p²=0.184), and the TWOB score of the real stimulation group was higher than that of the sham stimulation group (F=11.293, P=0.002, η_p²=0.225). Conclusion ·Combining iTBS with routine inpatient treatment can enhance the efficacy of reducing alcohol craving in alcohol-dependent patients during the withdrawal period, and improve their working memory.

Objective ·To observe the impact of hip synovitis on the long-term outcomes of free vascularized fibular grafting (FVFG) for osteonecrosis of femoral head (ONFH). Methods ·Between October 2001 and December 2013, 370 patients diagnosed with ONFH (556 hips) underwent FVFG. Preoperative synovitis was assessed using magnetic resonance imaging (MRI) and quantified with the Hip Inflammation MRI Scoring System (HIMRISS). Patients were divided into no synovitis group, moderate synovitis group, and severe synovitis group. Harris hip scores and the incidence of total hip arthroplasty were collected with an average follow-up duration of 90.5 months (range: 5‒215 months). Hip survival failure (defined as a Harris hip score lower than 80 at the final follow-up or the occurrence of total hip arthroplasty) was calculated. Multivariable Cox regression analysis was adopted to compare the influence of different degrees of synovial inflammation on long-term prognosis. Results ·The proportion of hip survival failure was 28.0% in patients without synovitis and 28.5% in those with moderate synovitis, whereas it was significantly higher (60.4%) in patients with severe synovitis. The results of multivariable Cox regression analysis showed that severe synovitis was an independent risk factor for poor prognosis ( HR 2.06, 95% CI 1.21‒3.53) after adjusting for age, gender, education level, marital status, ONFH type, affected side of ONFH, smoking history, baseline Harris hip score and other hip MRI-based covariates (collapse, bone marrow edema, and degeneration). Conclusion ·Severe synovitis in patients with ONFH significantly increases the failure rate of hip preservation after FVFG, and the severity of synovitis should be considered in surgical decision-making.

Objective ·To investigate the application effects and benefits of full-neuroendoscopic technique in the surgical treatment of posterior cranial fossa lesions. Methods ·A retrospective analysis was conducted on the clinical data of 105 patients with posterior cranial fossa lesions who underwent surgery using full-neuroendoscopic techniques at the Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, between January 2021 and December 2023. The data included patients′ gender, age, lesion locations, nature of lesions, surgical procedures, and postoperative recovery. Follow-up with contrast-enhanced MRI was performed one month postoperatively, with subsequent follow-ups every three months on average, depending on the nature of the lesions. Results ·Among the 105 patients, there were 45 males with an average age of (56±17) years and 60 females with an average age of (62±12) years. Lesions were predominantly located in the cerebellopontine angle area (78 cases), with others in the petrous bone area (7 cases), cerebellum (10 cases), and brainstem (10 cases). The nature of lesions included vestibular schwannoma (11 cases), meningioma (7 cases), glioma (7 cases), brain metastases (7 cases), hemangioblastoma (6 cases), cyst (1 case), and neuropathic conditions such as trigeminal neuralgia (43 cases), hemifacial spasm (22 cases), and glossopharyngeal neuralgia (1 case). All patients successfully underwent resection or biopsy of their lesions or microvascular decompression under full-neuroendoscopy. The follow-up period ranged from 3 months to 3 years. Enhanced MRI confirmed complete resection in 34 tumor cases (87.2%), near-total resection in 3 cases (7.7%), and biopsy in 2 cases (5.1%). Three deaths occurred during follow-up. Among the patients with vascular neuropathic diseases, two with trigeminal neuralgia experienced incomplete pain relief postoperatively. The resolution rates for hemifacial spasm and glossopharyngeal neuralgia were 100%. Postoperative complications occurred in 3 cases, with 2 cases of hydrocephalus that were managed with ventriculoperitoneal shunting, and 1 case of poor wound healing. Conclusion ·Full-neuroendoscopic technique demonstrates potential in the surgical treatment of posterior cranial fossa lesions.

Objective ·To construct and validate a nomogram for distinguishing primary Sjὅgren′s syndrome (PSS) from immunoglobulin G4-related sialadenitis (IgG4-RS) based on ultrasound scoring parameters and clinical indicators. Methods ·A total of 141 patients with PSS and 31 patients with IgG4-RS were retrospectively recruited from Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to December 2023. The ultrasound scoring parameters, including parotid gland ultrasound (PGUS) score, submandibular gland ultrasound (SMGUS) score, and salivary gland ultrasound (SGUS) score, along with clinical indicators such as gender, age, anti-SSB/La antibody, anti-SSA/Ro60 antibody, anti-SSA/Ro52 antibody, IgG, and rheumatoid factor (RF), were collected. The optimal US scoring parameters and clinical indicators were screened by least absolute shrinkage and selection operator (LASSO) regression, and a nomogram model was constructed to distinguish PSS from IgG4-RS. The internal validation of the model was carried out through bootstrap method. Receiver operator characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used to estimate the discrimination, calibration, and clinical utility of the nomogram model, respectively. Results ·LASSO regression identified six major variables: gender, age, anti-SSA/Ro60 antibody, anti-SSA/Ro52 antibody, PGUS score, and SMGUS score. These variables were used to construct the nomogram. ROC curve of the nomogram showed that the area under the curve (AUC) was 0.976, indicating the nomogram had strong discrimination ability. The bootstrap method was used for internal validation with 1 000 resampling iterations, and the average absolute error was 0.018. Calibration curve demonstrated good agreement between predicted and observed values. DCA indicated that the nomogram had certain clinical utility. Conclusion ·The nomogram based on ultrasound scoring parameters and clinical indicators demonstrates excellent discrimination and calibration in differentiating PSS from IgG4-RS. It has the potential to assist in clinical diagnosis and decision-making.

Objective ·To explore the application effect of a new type of blepharoplasty with a lower eyelid margin incision in the mid-face rejuvenation. Methods ·From September 2019 to September 2022, 35 patients with lower eyelid pouches, eyelid-cheek junction depression, and mid-face sagging were treated in Department of Plastic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine. The surgical procedure involved incising the lower eyelid margin of the patient, bluntly separating the orbital zygomatic space and maxillary space, and opening the orbital septum to release the orbital fat flap. Subsequently, the fat flap was spread downward to cover the infraorbital margin and fixed onto the zygomatic bone membrane. Then, the maxillary space was separated below the orbital zygomatic ligament, and the composite tissue in the infraorbital area was suspended and fixed outward and upward. The lateral orbicularis oculi muscle of the lower eyelid was suspended and fixed on the periosteum above the lateral orbital canthus, lifting the relaxed soft tissue in the mid-face. The upper and lower orbicularis oculi muscles were sutured to form a reclining silkworm, restoring the original tissue structure and morphology under the orbit. Outpatient follow-up visits were conducted at 1, 3, and 6 months postoperatively, with digital cameras capturing frontal, left lateral and right lateral views. Postoperative complications were recorded, including subcutaneous bruising, swelling, conjunctival edema, hematoma, eyelid separation, lower eyelid eversion, diplopia, strabismus, dry eyeball, and tear overflow. The patients were followed up irregularly 6‒12 months after surgery to observe the long-term effects. Results ·All 35 patients were followed up for 6 to 12 months after surgery, with all incisions healing primarily. The blepharoplasty, palpebral sulcus depression, and nasolabial sulcus folds were significantly improved. The sagging tissue of the mid-face was reduced, and the effect was satisfactory. No complications, such as lower eyelid retraction, ectropion, or infection, occurred. Conclusion ·The new type of eyelid blepharoplasty through the lower eyelid margin incision can significantly rejuvenate the lower eyelid and mid-face. This method has less trauma, less bleeding, reliable effect, and is easy to promote.